Just Another Work-Related Rant

Everyone has their own qualls at work that they need to deal with; not many people want to hear about others' crap. On the other hand, this is a form of output for me, so I'm gonna say it anyway.


Some days, everything goes fine. I go to work, and my co-workers stick to what they're supposed to do. Tasks are completed, I'm not stuck picking up the slack for a group of people, and things are prepared the way they're supposed to be. Working with people that have developmental disabilities puts us (the direct support staff) in a position of great responsibility and power over other people's lives. However, some days, I think some of us forget all about that and just do whatever the hell makes our own lives easier. This results in friction between staff, miscommunication, and lost time that ultimately leads to maltreatment in various forms - medication errors, missed activities or appointments, negligence, and even legal issues. Certainly no one person is to blame since there are multiple problems, but perhaps that is what makes it so bad.


As direct support staff for people with developmental disabilities, we've been given the task of administering medications for these people. We staff have all gone through a two-full-day training session, paper and skill testing, and orientation for our particular work site to ensure we are competent enough to do it properly. Considering the fact that administering medications can have drastic results if NOT done properly, we should probably make damned sure we're doing it right. Why, then, do I see so many gaps on the med administration record? Were the meds given? Why are we running out of a 30-day supply of liquid medication in ten days? Why, when the pharmacy provides us with medications stocked in monthly bubble packs, and EACH PILL labeled with each day, do we have multiple partially-filled packs? Why is the 60-dose bottle of use-as-needed medication gone after 20 days, with no documentation to show for it? Why is one person's nasal spray in another person's medication box? Is it because you want to watch American Idol and aren't paying attention? Is it because you had an outing that kept you out a bit late and now you're rushing to ensure you aren't at work a second later than you're scheduled? Are you trying to do too much now because you were sitting on your ass earlier? Is it because you just don't care? Or, and I give people the benefit of the doubt with this one, do you just not know how to do it correctly anymore?


This is all about people taking responsibility for their own tasks. It seems like people don't plan out anything - they think stuff is just gonna happen on its own, and the high-functioning nature of the house we work at just makes the day a Lazy River. Then when someone realizes they didn't do everything they were supposed to, they either rush to do it and screw it up or they delegate it to someone else (who may have a hefty to-do list in the first place). "Oh, shit - I forgot to do this one thing; I'll jet an email off to Adam, and ask him to take care of it. Ooo, while I'm at it, I'll ask him to take care of this other thing, since I have been thinking about it for a couple weeks and it needs to be done by tomorrow. Then, while I'm driving home, I'll remember something else and send him a text, too. Oh, yeah - and when he is driving to work tomorrow morning, I'll send him another text and ask him to do something that is physically impossible for him to do as it requires him to be in two places at the same time." Sorry if I sound like a martyr, but this situation is actually commonplace. Guess what happens? People miss appointments, or they don't get a ride home from work, or they don't get to go to their activity which puts them in a behavioral frenzy of whipping all their belongings out of their bedroom at we moving targets, leading to a miserable day of all the other residents being quarantined in another corner of the house so they won't get hurt.


Honestly, I can deal with these situations of having additional tasks fairly well. I find alternative ways of doing things, or go out of my way to make something work. The thing is, these issues are totally preventable with more preparation and better communication, which leads to my next point - proper communication. This is something that is so extremely lax in our workplace, that even though I'm a (slight) superior that's here 40 hours a week, I still have no f***ing clue what is going on most of the time.


Someone has a dental appointment today? Sweet, okay - Um, is the person's ride canceled? Dunno - it doesn't say in the appointment book under "Ride/Work informed?"... Okay, gotta call them quick. Let's see, what's the dental appointment for - is this a routine cleaning, cavity filling, or what? Hmm... Doesn't say on the calendar, in the appointment book, or on the referral form that isn't filled out. Alright, whatever - I'm sure the office will know why they're there once we show up (sometimes they don't). Alright, now where is this appointment? I see something scribbled on the calendar, but I can't read it... Uh, nothing in the appointment book or on the referral form; I guess I'll check their health progress notes and see if it says anything about the appointment in there... Aha, yes - 6 months back it says, "Next appt in 6 mos." Lucky me! Dr. Ekswyzee... Well, still doesn't say WHERE... Guess I'll do some Google searching and find out where this doctor is working. There we go - looks like the Park Nicollet in St. Louis Park - I'll call and make sure...


This is me, every day.


All this information that I have to hunt around for could have simply been written down in 30 seconds, and would save me the 20 minutes of work. I'm quite sure a five-fold quantity of time is accurate as to how much more work I have to do to figure out the situation, on top of me feeling like a complete ass hat in the situations when none of us know what the hell we're doing at the medical appointments in the first place.


Same thing with activities and events, and food/clothes/other stuff that randomly shows up at the house, and issues with the people's workplaces, and new support objectives for the people, and protocols for medications or treatment, and lots of other random things. There will be one (or zero) piece(s) of documentation about these things, and the inability to get a hold of the author leaves people with a cryptic message they need to try to get to the bottom of, only having the very selfish, skewed voiced desires of the residents to work off of. On the flip side of that, when *I* leave a piece of documentation for everyone to read and/or follow, even if I leave it in the most reliable place, it seems it doesn't get read. I have a note right next to the fax machine requesting that people look at my recent medication orders before faxing an order for something that we're running out of, since, chances are I'll have already placed an order for it. But we'll still end up with double what we ordered - this can become an issue since medical assistance won't always cover extra orders. I try to improve medical documentation by requesting that, on a daily basis, the person NOT passing medications check all the med records at the end of the day to make sure everything is completed and initialed by the med passer; I have instructions on how to do this posted ON THE DOORS of the medication cabinets, along with a calendar for the "med checker" to initial once they've done it for the day - 7 of the last 90 days are initialed, 3 of which are my own (I was working different hours the first few weeks of that calendar). And, by the way, this process was something that we did up until a couple years ago, so many of the staff are already familiar with it. To be fair, incidents of missed documentation are few and far between, but they could be indicative of someone not getting their delicately-controlled seizure medication.


Often times, I really wish we could have fully computerized documentation. We'd be able to have all the med administration stuff in there, all the communication notes, all appointments, and an holistic index of information regarding the vast complexity of the house. On the other hand, there'd have to be some major training sessions involved with computer use, I estimate that not everyone can type as fast as they can write, and we'd have to get computers for all the company's houses - honestly, small prices to pay considering the potential benefits.


Now, since I coincidentally am at work right now, I've cumulatively used up all my break time for the day typing this up. Time to get back to doing something that probably isn't my job. ;)
~A